Expert intrapartum maternity care: a meta-synthesis

AIM: This paper reports a meta-synthesis exploring the accounts of intrapartum midwifery skills, practices, beliefs and philosophies given by practitioners working in the field of intrapartum maternity care who are termed expert, exemplary, excellent or experienced. BACKGROUND: Expertise in nursing and medicine has been widely debated and researched. However, there appear to be few studies of practitioners' accounts of expertise in the context of maternity care. Given current international debates on the need to promote safe motherhood, and, simultaneously, on the need to reverse rising rates of routine intrapartum intervention, an examination of the nature of maternity care expertise is timely. METHOD: A systematic review and meta-synthesis were undertaken. Twelve databases and 50 relevant health and social science journals were searched by hand or electronically for papers published in English between 1970 and June 2006, using predefined search terms, inclusion, exclusion and quality criteria. FINDINGS: Seven papers met the criteria for this review. Five of these included qualified and licensed midwives, and two included labour ward nurses. Five studies were undertaken in the USA and two in Sweden. The quality of the included studies was good. Ten themes were identified by consensus. After discussion, three intersecting concepts were identified. These were: wisdom, skilled practice and enacted vocation. CONCLUSION: The derived concepts provide a possible first step in developing a theory of expert intrapartum non-physician maternity care. They may also offer more general insights into aspects of clinical expertise across healthcare groups. Maternity systems that limit the capacity of expert practitioners to perform within the domains identified may not deliver optimal care. If further empirical studies verify that the identified domains maximize effective intrapartum maternity care, education and maternity care systems will need to be designed to accommodate them.     

Quality of measures on respectful and disrespectful maternity care: A systematic review

This systematic review aimed to critique the process of development and psychometric properties of tools measuring respectful or disrespectful maternity care experienced by women during labor and birth in low‐ and middle‐income countries. The MEDLINE, Embase, CINAHL, Web of Science, PubMed, and Cochrane Library electronic databases were systematically searched from their inception to February 2020. Methodological quality was assessed using the COnsensus‐based Standards for the selection of health Measurement INstruments checklist. Six tools measuring respectful maternity care during the intrapartum period were identified. Measurement error, cross‐cultural validity, and responsiveness were not evaluated by any tool developers, while structural validity, internal consistency, and hypothesis testing were the most frequently assessed measurement properties. Interestingly, this review could not identify any measures of disrespectful care even though most included measures focused on disrespect and abuse. No measure was of sufficient quality to determine women's experiences of disrespectful and respectful maternity care in low‐ and middle‐income countries. New valid and reliable measures using rigorous approaches to tool development are required.     

Elements of a systematic review

This paper examines the subject of systematic reviews from a nursing viewpoint. The history of the evidence-based healthcare movement and the major differences between systematic reviews and traditional literature reviews are discussed. The steps of the process used by those conducting reviews are examined in detail. These include structuring a research question, searching and appraising the literature, data extraction, analysis and synthesis, and reporting the results. It is this process that ensures reviews can be considered as a legitimate form of nursing research.     

Equality as a central concept of nursing ethics: a systematic literature review

Scand J Caring Sci; 2010; 24; 824–832
Equality as a central concept of nursing ethics: a systematic literature review Background: Equality is a central concept in the Western way of thinking and in health care. In ethics research within nursing science, equality is a key concept but the meaning of its contents is more or less presumptive. Aim: The purpose of this study was to define the concept of equality as a value of nursing ethics research. Method: Data were collected through systematic literature review and analysed using deductive and inductive content analysis. Findings: Equality has been studied as a concept and in relation to ethical theories. In nursing ethics, research on equality on theoretical and functional level is presented. These levels consist of dimensions, i.e. themes, that equality is related to. The dimensions of the theoretical level are the equality of being, i.e. universal human value, and distributive equality, i.e. equal opportunities, circumstances and results. The dimensions of functional equality included themes such as critique of distributive equality, context, difference, power and care. Critique is aimed at incompatibility of theoretical level with practice. Context raises questions of each nursing situation in relation to equality. Variation within context is closely related to differences involving parties to nursing, and it is a starting point to questions of equality. Power is understood as comprising knowledge, skills and authority that create differences and questions of equality between nurses and patients and nurses and other professionals or students. Nursing as care always includes relationship between two or more persons and needs to be inspected from the point of view of equality. Conclusion: The concept of equality has been complex to achieve in practice. The dimensions of the levels of equality defined in this study provide an opportunity to reach a better understanding of equality in nursing ethics. There is still a great demand for more research on the concept of equality.     

Competencies and skills for remote and rural maternity care: a review of the literature

AIM: This paper reports a review of the literature on skills, competencies and continuing professional development necessary for sustainable remote and rural maternity care. BACKGROUND: There is a general sense that maternity care providers in rural areas need specific skills and competencies. However, how these differ from generic skills and competencies is often unclear. METHODS: Approaches used to access the research studies included a comprehensive search in relevant electronic databases using relevant keywords (e.g. 'remote', 'midwifery', 'obstetrics', 'nurse-midwives', education', 'hospitals', 'skills', 'competencies', etc.). Experts were approached for (un-)published literature, and books and journals known to the authors were also used. Key journals were hand searched and references were followed up. The original search was conducted in 2004 and updated in 2006. FINDINGS: Little published literature exists on professional education, training or continuous professional development in maternity care in remote and rural settings. Although we found a large literature on competency, little was specific to competencies for rural practice or for maternity care. 'Hands-on' skills courses such as Advanced Life Support in Obstetrics and the Neonatal Resuscitation Programme increase confidence in practice, but no published evidence of effectiveness of such courses exists. CONCLUSION: Educators need to be aware of the barriers facing rural practitioners, and there is potential for increasing distant learning facilitated by videoconferencing or Internet access. They should also consider other assessment methods than portfolios. More research is needed on the levels of skills and competencies required for maternity care professionals practising in remote and rural areas.     

Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature

Title. Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature. Aim. This paper is a report of a systematic review to identify and analyse the main factors affecting the utilization of antenatal care in developing countries. Background. Antenatal care is a key strategy for reducing maternal mortality, but millions of women in developing countries do not receive it. Data sources. A range of electronic databases was searched for studies conducted in developing countries and published between 1990 and 2006. English‐language publications were searched using relevant keywords, and reference lists were hand‐searched. Review methods. A systematic review was carried out and both quantitative and qualitative studies were included. Results. Twenty‐eight papers were included in the review. Studies most commonly identified the following factors affecting antenatal care uptake: maternal education, husband’s education, marital status, availability, cost, household income, women’s employment, media exposure and having a history of obstetric complications. Cultural beliefs and ideas about pregnancy also had an influence on antenatal care use. Parity had a statistically significant negative effect on adequate attendance. Whilst women of higher parity tend to use antenatal care less, there is interaction with women’s age and religion. Only one study examined the effect of the quality of antenatal services on utilization. None identified an association between the utilization of such services and satisfaction with them. Conclusion. More qualitative research is required to explore the effect of women’s satisfaction, autonomy and gender role in the decision‐making process. Adequate utilization of antenatal care cannot be achieved merely by establishing health centres; women’s overall (social, political and economic) status needs to be considered.     

Clinical guidelines in nursing, midwifery and the therapies: a systematic review

BACKGROUND: While nursing, midwifery and professions allied to medicine (PAMs) are increasingly using clinical guidelines to reduce inappropriate variations in practice and ensure higher quality care, there have been no rigorous overviews of their effectiveness in relation to these professions. We identified 18 evaluations of guidelines which met established quality for evaluations of interventions aimed at changing professional practice. This paper describes characteristics of guidelines evaluated and the effectiveness of different dissemination and implementation strategies used. METHODS: Guideline evaluations conducted since 1975 which used a randomized controlled trial, controlled before-and-after, or interrupted time-series design, were identified using a combination of database and hand searching. FINDINGS: It is mostly impossible to tell whether the guidelines evaluated were based on evidence. The most common method of guideline dissemination was the distribution of printed educational materials. Three studies compared different dissemination and/or implementation strategies: findings suggest educational interventions may be of value in the dissemination of guidelines and confer a benefit over passive dissemination.     

Surgical hand scrubs in relation to microbial counts: systematic literature review

AIM: This paper reports a systematic review whose objective was to determine the effectiveness of surgical hand scrubs in relation to bacterial growth on the hands of operating room staff members. BACKGROUND: Despite the need for surgical hand scrubs, evidence shows that frequent and prolonged use of antiseptics and brushes may damage the skin. Consequently, lesions may appear, become more heavily colonized by microorganisms and increase the risk of transmitting infection to patients. Recommendations about surgical hand scrubs vary widely and their effectiveness in relation to microbial counts is unknown. METHOD: A variety of healthcare databases were searched covering the period between January 1990 and December 2004. Based on selection criteria, the abstracts of studies identified were checked to determine whether they fulfilled the inclusion criteria. All studies were assessed as having adequate methodological quality. Using Cochrane Review Manager 4.2 software, weighted mean difference and 95% confidence intervals were calculated. FINDINGS: Three studies were included in this review. Two studies compared the effectiveness of surgical hand scrubs using an alcohol-based product and a 6-minute scrub using 4% chlorhexidine gluconate; meta-analysis showed a statistically significant difference (weighted mean difference = -0.63, 95% confidence intervals = -0.99 to -0.27, P = 0.0006). One study compared the effectiveness of 2- and 3-minute surgical hand scrubs using 4% chlorhexidine gluconate; meta-analysis showed no difference (weighted mean difference = 0.29, 95% confidence intervals = -0.13 to 0.71, P = 0.18). CONCLUSION: Surgical hand scrubs using an alcohol-based product were more effective than a 6-minute scrub using 4% chlorhexidine gluconate. There is no evidence to support a 2-minute surgical hand scrub as being more effective than a 3-minute one using 4% chlorhexidine gluconate.     

A systematic review of instruments measuring patients′ perceptions of patient‐centred nursing care

This systematic review identified and evaluated instruments measuring patients' perceptions of patient‐centred nursing care. Of 2629 studies reviewed, 12 were eligible for inclusion. Four instruments were reported: The Individualized Care Scale, the Client‐Centred Care Questionnaire, the Oncology patients' Perceptions of the Quality of Nursing Care Scale and the Smoliner scale. These instruments cover themes addressing patient participation and the clinician–patient relationship. Instruments were shown to have satisfactory psychometric properties, although not all were adequately assessed. More research is needed regarding test–retest reliability, convergent and discriminant validity, validity with known groups and structural validity using confirmatory factor analysis.